Contents
- 413.1 Introduction.
- 413.100 Special treatment of certain accrued costs.
- 413.102 Compensation of owners.
- 413.106 Reasonable cost of physical and other therapy services furnished under arrangements.
- 413.114 Payment for posthospital SNF care furnished by a swing-bed hospital.
- 413.118 Payment for facility services related to covered ASC surgical procedures performed in hospitals on an outpatient basis.
- 413.122 Payment for hospital outpatient radiology services and other diagnostic procedures.
- 413.123 Payment for screening mammography performed by hospitals on an outpatient basis.
- 413.124 Reduction to hospital outpatient operating costs.
- 413.125 Payment for home health agency services.
- 413.13 Amount of payment if customary charges for services furnished are less than reasonable costs.
- 413.130 Introduction to capital-related costs.
- 413.134 Depreciation: Allowance for depreciation based on asset costs.
- 413.139 Depreciation: Optional allowance for depreciation based on a percentage of operating costs.
- 413.144 Depreciation: Allowance for depreciation on fully depreciated or partially depreciated assets.
- 413.149 Depreciation: Allowance for depreciation on assets financed with Federal or public funds.
- 413.153 Interest expense.
- 413.157 Return on equity capital of proprietary providers.
- 413.17 Cost to related organizations.
- 413.170 Scope.
- 413.171 Definitions.
- 413.172 Principles of prospective payment.
- 413.174 Prospective rates for hospital-based and independent ESRD facilities.
- 413.176 Amount of payments.
- 413.177 Quality incentive program payment.
- 413.178 ESRD quality incentive program.
- 413.180 Procedures for requesting exceptions to payment rates.
- 413.182 Criteria for approval of exception requests.
- 413.184 Payment exception: Pediatric patient mix.
- 413.186 Payment exception: Self-dialysis training costs in pediatric facilities.
- 413.194 Appeals.
- 413.195 Limitation on Review.
- 413.196 Notification of changes in rate-setting methodologies and payment rates.
- 413.198 Recordkeeping and cost reporting requirements for outpatient maintenance dialysis.
- 413.20 Financial data and reports.
- 413.200 [Reserved]
- 413.202 Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries.
- 413.203 Transplant center costs for organs sent to foreign countries or transplanted in patients other than Medicare beneficiaries.
- 413.210 Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.
- 413.215 Basis of payment.
- 413.217 Items and services included in the ESRD prospective payment system.
- 413.220 Methodology for calculating the per-treatment base rate under the ESRD prospective payment system effective January 1, 2011.
- 413.230 Determining the per treatment payment amount.
- 413.231 Adjustment for wages.
- 413.232 Low-volume adjustment.
- 413.233 Additional facility-level adjustments.
- 413.234 Drug designation process.
- 413.235 Patient-level adjustments.
- 413.236 Transitional add-on payment adjustment for new and innovative equipment and supplies.
- 413.237 Outliers.
- 413.239 Transition period.
- 413.24 Adequate cost data and cost finding.
- 413.241 Pharmacy arrangements.
- 413.30 Limitations on payable costs.
- 413.300 Basis and scope.
- 413.302 Definitions.
- 413.304 Eligibility for prospectively determined payment rates.
- 413.308 Rules governing election of prospectively determined payment rates.
- 413.310 Basis of payment.
- 413.312 Methodology for calculating rates.
- 413.314 Determining payment amounts: Routine per diem rate.
- 413.316 Determining payment amounts: Ancillary services.
- 413.320 Publication of prospectively determined payment rates or amounts.
- 413.321 Simplified cost report for SNFs.
- 413.330 Basis and scope.
- 413.333 Definitions.
- 413.335 Basis of payment.
- 413.337 Methodology for calculating the prospective payment rates.
- 413.338 Skilled nursing facility value-based purchasing program.
- 413.340 Transition period.
- 413.343 Resident assessment data.
- 413.345 Publication of Federal prospective payment rates.
- 413.348 Limitation on review.
- 413.35 Limitations on coverage of costs: Charges to beneficiaries if cost limits are applied to services.
- 413.350 Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A services.
- 413.355 Additional payment: QIO reimbursement for cost of sending records electronically or by photocopy and mailing.
- 413.360 Requirements under the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP).
- 413.370 Scope.
- 413.371 Definition.
- 413.372 AKI dialysis payment rate.
- 413.373 Other adjustments to the AKI dialysis payment rate.
- 413.374 Renal dialysis services included in the AKI dialysis payment rate.
- 413.375 Notification of changes in rate-setting methodologies and payment rates.
- 413.40 Ceiling on the rate of increase in hospital inpatient costs.
- 413.400 Definitions.
- 413.402 Organ acquisition costs.
- 413.404 Standard acquisition charge.
- 413.406 Acquisition of pancreata for islet cell transplant.
- 413.408 [Reserved]
- 413.410 [Reserved]
- 413.412 Intent to transplant, intent for research, counting en bloc, and unusable organs.
- 413.414 Medicare secondary payer and organ acquisition costs.
- 413.416 Organ acquisition charges for kidney-paired exchanges.
- 413.418 Amounts billed to organ procurement organizations for hospital services provided to deceased donors and included as organ acquisition costs.
- 413.420 Payment to independent organ procurement organizations (IOPOs) and histocompatibility laboratories (HCLs) for organ acquisition costs.
- 413.5 Cost reimbursement: General.
- 413.50 Apportionment of allowable costs.
- 413.53 Determination of cost of services to beneficiaries.
- 413.56 [Reserved]
- 413.60 Payments to providers: General.
- 413.64 Payments to providers: Specific rules.
- 413.65 Requirements for a determination that a facility or an organization has provider-based status.
- 413.70 Payment for services of a CAH.
- 413.74 Payment to a foreign hospital.
- 413.75 Direct GME payments: General requirements.
- 413.76 Direct GME payments: Calculation of payments for GME costs.
- 413.77 Direct GME payments: Determination of per resident amounts.
- 413.78 Direct GME payments: Determination of the total number of FTE residents.
- 413.79 Direct GME payments: Determination of the weighted number of FTE residents.
- 413.80 Direct GME payments: Determination of weighting factors for foreign medical graduates.
- 413.81 Direct GME payments: Application of community support and redistribution of costs in determining FTE resident counts.
- 413.82 Direct GME payments: Special rules for States that formerly had a waiver from Medicare reimbursement principles.
- 413.83 Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific rate.
- 413.84 Prohibition against unlawful discrimination.
- 413.85 Cost of approved nursing and allied health education activities.
- 413.87 Payments for Medicare + Choice nursing and allied health education programs.
- 413.88 Incentive payments under plans for voluntary reduction in number of medical residents.
- 413.89 Bad debts, charity, and courtesy allowances.
- 413.9 Cost related to patient care.
- 413.90 Research costs.
- 413.92 Costs of surety bonds.
- 413.94 Value of services of nonpaid workers.
- 413.98 Purchase discounts and allowances, and refunds of expenses.
- 413.99 Qualified and Non-Qualified Deferred Compensation Plans.
Contents
2,587 provisions, too many to show on one page. Open a part or section to read it with its history and connections, or search inside the text.
- 413.1 · Introduction.
- 413.100 · Special treatment of certain accrued costs.
- 413.102 · Compensation of owners.
- 413.106 · Reasonable cost of physical and other therapy services furnished under arrangements.
- 413.114 · Payment for posthospital SNF care furnished by a swing-bed hospital.
- 413.118 · Payment for facility services related to covered ASC surgical procedures performed in hospitals on an outpatient basis.
- 413.122 · Payment for hospital outpatient radiology services and other diagnostic procedures.
- 413.123 · Payment for screening mammography performed by hospitals on an outpatient basis.
- 413.124 · Reduction to hospital outpatient operating costs.
- 413.125 · Payment for home health agency services.
- 413.13 · Amount of payment if customary charges for services furnished are less than reasonable costs.
- 413.130 · Introduction to capital-related costs.
- 413.134 · Depreciation: Allowance for depreciation based on asset costs.
- 413.139 · Depreciation: Optional allowance for depreciation based on a percentage of operating costs.
- 413.144 · Depreciation: Allowance for depreciation on fully depreciated or partially depreciated assets.
- 413.149 · Depreciation: Allowance for depreciation on assets financed with Federal or public funds.
- 413.153 · Interest expense.
- 413.157 · Return on equity capital of proprietary providers.
- 413.17 · Cost to related organizations.
- 413.170 · Scope.
- 413.171 · Definitions.
- 413.172 · Principles of prospective payment.
- 413.174 · Prospective rates for hospital-based and independent ESRD facilities.
- 413.176 · Amount of payments.
- 413.177 · Quality incentive program payment.
- 413.178 · ESRD quality incentive program.
- 413.180 · Procedures for requesting exceptions to payment rates.
- 413.182 · Criteria for approval of exception requests.
- 413.184 · Payment exception: Pediatric patient mix.
- 413.186 · Payment exception: Self-dialysis training costs in pediatric facilities.
- 413.194 · Appeals.
- 413.195 · Limitation on Review.
- 413.196 · Notification of changes in rate-setting methodologies and payment rates.
- 413.198 · Recordkeeping and cost reporting requirements for outpatient maintenance dialysis.
- 413.20 · Financial data and reports.
- 413.200 · [Reserved]
- 413.202 · Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries.
- 413.203 · Transplant center costs for organs sent to foreign countries or transplanted in patients other than Medicare beneficiaries.
- 413.210 · Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.
- 413.215 · Basis of payment.
- 413.217 · Items and services included in the ESRD prospective payment system.
- 413.220 · Methodology for calculating the per-treatment base rate under the ESRD prospective payment system effective January 1, 2011.
- 413.230 · Determining the per treatment payment amount.
- 413.231 · Adjustment for wages.
- 413.232 · Low-volume adjustment.
- 413.233 · Additional facility-level adjustments.
- 413.234 · Drug designation process.
- 413.235 · Patient-level adjustments.
- 413.236 · Transitional add-on payment adjustment for new and innovative equipment and supplies.
- 413.237 · Outliers.
- 413.239 · Transition period.
- 413.24 · Adequate cost data and cost finding.
- 413.241 · Pharmacy arrangements.
- 413.30 · Limitations on payable costs.
- 413.300 · Basis and scope.
- 413.302 · Definitions.
- 413.304 · Eligibility for prospectively determined payment rates.
- 413.308 · Rules governing election of prospectively determined payment rates.
- 413.310 · Basis of payment.
- 413.312 · Methodology for calculating rates.
- 413.314 · Determining payment amounts: Routine per diem rate.
- 413.316 · Determining payment amounts: Ancillary services.
- 413.320 · Publication of prospectively determined payment rates or amounts.
- 413.321 · Simplified cost report for SNFs.
- 413.330 · Basis and scope.
- 413.333 · Definitions.
- 413.335 · Basis of payment.
- 413.337 · Methodology for calculating the prospective payment rates.
- 413.338 · Skilled nursing facility value-based purchasing program.
- 413.340 · Transition period.
- 413.343 · Resident assessment data.
- 413.345 · Publication of Federal prospective payment rates.
- 413.348 · Limitation on review.
- 413.35 · Limitations on coverage of costs: Charges to beneficiaries if cost limits are applied to services.
- 413.350 · Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A services.
- 413.355 · Additional payment: QIO reimbursement for cost of sending records electronically or by photocopy and mailing.
- 413.360 · Requirements under the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP).
- 413.370 · Scope.
- 413.371 · Definition.
- 413.372 · AKI dialysis payment rate.
- 413.373 · Other adjustments to the AKI dialysis payment rate.
- 413.374 · Renal dialysis services included in the AKI dialysis payment rate.
- 413.375 · Notification of changes in rate-setting methodologies and payment rates.
- 413.40 · Ceiling on the rate of increase in hospital inpatient costs.
- 413.400 · Definitions.
- 413.402 · Organ acquisition costs.
- 413.404 · Standard acquisition charge.
- 413.406 · Acquisition of pancreata for islet cell transplant.
- 413.408 · [Reserved]
- 413.410 · [Reserved]
- 413.412 · Intent to transplant, intent for research, counting en bloc, and unusable organs.
- 413.414 · Medicare secondary payer and organ acquisition costs.
- 413.416 · Organ acquisition charges for kidney-paired exchanges.
- 413.418 · Amounts billed to organ procurement organizations for hospital services provided to deceased donors and included as organ acquisition costs.
- 413.420 · Payment to independent organ procurement organizations (IOPOs) and histocompatibility laboratories (HCLs) for organ acquisition costs.
- 413.5 · Cost reimbursement: General.
- 413.50 · Apportionment of allowable costs.
- 413.53 · Determination of cost of services to beneficiaries.
- 413.56 · [Reserved]
- 413.60 · Payments to providers: General.
- 413.64 · Payments to providers: Specific rules.
- 413.65 · Requirements for a determination that a facility or an organization has provider-based status.
- 413.70 · Payment for services of a CAH.
- 413.74 · Payment to a foreign hospital.
- 413.75 · Direct GME payments: General requirements.
- 413.76 · Direct GME payments: Calculation of payments for GME costs.
- 413.77 · Direct GME payments: Determination of per resident amounts.
- 413.78 · Direct GME payments: Determination of the total number of FTE residents.
- 413.79 · Direct GME payments: Determination of the weighted number of FTE residents.
- 413.80 · Direct GME payments: Determination of weighting factors for foreign medical graduates.
- 413.81 · Direct GME payments: Application of community support and redistribution of costs in determining FTE resident counts.
- 413.82 · Direct GME payments: Special rules for States that formerly had a waiver from Medicare reimbursement principles.
- 413.83 · Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific rate.
- 413.84 · Prohibition against unlawful discrimination.
- 413.85 · Cost of approved nursing and allied health education activities.
- 413.87 · Payments for Medicare + Choice nursing and allied health education programs.
- 413.88 · Incentive payments under plans for voluntary reduction in number of medical residents.
- 413.89 · Bad debts, charity, and courtesy allowances.
- 413.9 · Cost related to patient care.
- 413.90 · Research costs.
- 413.92 · Costs of surety bonds.
- 413.94 · Value of services of nonpaid workers.
- 413.98 · Purchase discounts and allowances, and refunds of expenses.
- 413.99 · Qualified and Non-Qualified Deferred Compensation Plans.
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